Calcitonin

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Calcitonin Brand Names- Fortical | Miacalcin

What is Calcitonin

Calcitonin is a polypeptide hormone produced in the parafollicular (C) cells of the thyroid gland in humans; the hormone binds directly to receptors on the osteoclast surface, inhibiting bone resorption and decreases serum calcium.

Commercial preparations of salmon calcitonin are prepared synthetically or using recombinant DNA methods.

Salmon calcitonin is 40 to 50 times more potent and has a longer duration than human calcitonin; its structure differs from human calcitonin by 13 amino acid residues.

Calcitonin has been used in the treatment of Paget’s disease of the bone, either alone or with other agents for the management of hypercalcemia, and for postmenopausal osteoporosis.

Injectable calcitonin is used clinically in treatment protocols hypercalcemic emergencies to help produce a rapid decrease in serum calcium until more specific treatment of the underlying disease is instituted.

Injectable and intranasal calcitonin therapy prevents bone loss and increases bone density in the vertebral spine in postmenopausal women with osteoporosis; some studies have shown a reduction in future vertebral fracture with use.

Guidelines generally recommend against calcitonin for the treatment of osteoporosis; the efficacy of calcitonin in preventing non-vertebral fractures is not established, and the increase in bone mineral density is less than that reported for other agents (e.g., bisphosphonates).

Calcitonin may be considered for women who can not or will not take more effective agents; use within 5 years of menopause onset is not recommended as benefit/efficacy has not been observed in early menopause.

Calcitonin may reduce the pain of acute osteoporotic vertebral fractures and is sometimes used short-term for this purpose off-label, but there is no sufficient data that calcitonin is effective for chronic pain due to prior osteoporotic vertebral fractures.

The potential analgesic effect of calcitonin continues to be investigated for other types of bone fracture and for patients with bone metastases due to cancer.

For Paget’s disease, the use of injectable calcitonin leads to partial radiographic healing of lytic lesions, but most patients do not achieve normalization of bone turnover, and thus calcitonin has limited use versus newer, more effective agents (i.e., bisphosphonates).

The first salmon calcitonin injectable product was FDA-approved in 1975. A human calcitonin product approved in 1986 is no longer marketed.

Intranasal salmon calcitonin products were initially FDA-approved in 1995.

Oral calcitonin dosage forms have been investigated but trials have been discontinued due to lack of efficacy.

Indications

  1. bone pain
  2. hypercalcemia
  3. osteoporosis
  4. Paget’s disease

Side Effects

  1. abdominal pain
  2. agitation
  3. alopecia
  4. anaphylactic shock
  5. anaphylactoid reactions
  6. anemia
  7. angina
  8. angioedema
  9. anorexia
  10. antibody formation
  11. anxiety
  12. appetite stimulation
  13. arthralgia
  14. back pain
  15. blurred vision
  16. bronchospasm
  17. bundle-branch block
  18. cholelithiasis
  19. conjunctivitis
  20. constipation
  21. cough
  22. cystitis
  23. depression
  24. diaphoresis
  25. diarrhea
  26. dizziness
  27. dysgeusia
  28. dyspepsia
  29. dyspnea
  30. edema
  31. epistaxis
  32. fatigue
  33. fever
  34. flatulence
  35. flushing
  36. gastritis
  37. goiter
  38. headache
  39. hearing loss
  40. hematuria
  41. hepatitis
  42. hypertension
  43. hyperthyroidism
  44. hypocalcemia
  45. hypotension
  46. infection
  47. injection site reaction
  48. insomnia
  49. lacrimation
  50. laryngeal edema
  51. lymphadenopathy
  52. migraine
  53. muscle cramps
  54. myalgia
  55. myocardial infarction
  56. nasal congestion
  57. nasal dryness
  58. nasal irritation
  59. nausea
  60. nephrolithiasis
  61. new primary malignancy
  62. nocturia
  63. ocular pain
  64. otalgia
  65. palpitations
  66. paresthesias
  67. parosmia
  68. peripheral edema
  69. pharyngitis
  70. phlebitis
  71. polyuria
  72. pruritus
  73. rash
  74. rhinitis
  75. seizures
  76. sinus tachycardia
  77. sinusitis
  78. skin ulcer
  79. sneezing
  80. stroke
  81. tetany
  82. tinnitus
  83. tremor
  84. urticaria
  85. vertigo
  86. vomiting
  87. weight gain
  88. xerostomia

Monitoring Parameters

  • serum 25(OH)hydroxyvitamin D concentrations
  • serum alkaline phosphatase
  • serum calcium
  • urinalysis

Contraindications

  • breast-feeding
  • fish hypersensitivity
  • geriatric
  • hypocalcemia
  • nasal trauma
  • new primary malignancy
  • pregnancy

Interactions

  • Calcifediol
  • Calcitriol
  • Calcium
  • Calcium Acetate
  • Calcium Carbonate
  • Calcium Carbonate; Magnesium Hydroxide
  • Calcium Carbonate; Risedronate
  • Calcium Carbonate; Simethicone
  • Calcium Chloride
  • Calcium Gluconate
  • Calcium; Vitamin D
  • Chromium
  • Denosumab
  • Dihydrotachysterol
  • Doxercalciferol
  • Hetastarch; Dextrose; Electrolytes
  • Lithium
  • Paricalcitol
  • Vitamin D analogs

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